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Paget's disease (bone scintigraphy)

Case contributed by Kevin Banks
Diagnosis almost certain

Presentation

Elevated alkaline phosphatase.

Patient Data

Age: 55 years old
Gender: Male
Nuclear medicine

Whole body bone scan with spot images of the pelvis performed using 25 mCi of Tc99m-MDP IV.

Images demonstrate abnormal intense cortical radiotracer uptake throughout the entirely of the right hemi pelvis. The right hemi pelvis also looks slightly expanded compared to the left hemi pelvis, seen best of the posterior views.

X-ray of the pelvis shows cortical thickening and mild expansion of the right iliac bone.

Axial T1 weighted sequences show low signal intensity in the osseous right hemipelvis with mild patchy enhancement.

Case Discussion

Skeletal scintigraphy has high sensitivity for detecting the increased vascularity and osteoblastic activity characteristic of Paget’s disease. Scintigraphy is not specific however, and the differential diagnosis of Pagetoid lesions can include metastasis, metabolic bone disease, and fibrous dysplasia.

As in this case, the disease is frequently identified because of an elevation in serum alkaline phosphatase, which reflects the extent and the activity of Paget's.

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